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Snohomish Health District is the local public health agency for Snohomish County in Washington state. Our news releases are a resource for current public health information for media, the public, policymakers, and other community partners.

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Immunizations & Travel Services & Pertussis & Educational Opportunity

Action requested: Take steps to assure your patients have access to immunizations.

Background & Recommendations

In my March 13 alert, I noted that the Health District will close our immunization and travel clinics by the end of June. Some issues not addressed in that alert deserve attention.

First, be cautious about referring children who need vaccinations to pharmacies. Not all pharmacies vaccinate children. To our knowledge, no pharmacies participate in the Vaccines for Children (VFC) program that supplies vaccines at no charge and none vaccinate children younger than 2 years old. Finally, Apple Health (Medicaid) may not be accepted at all pharmacies. Consequently, families seeking vaccinations at pharmacies could have large out-of-pocket charges for the service. In general, children should receive their vaccinations through providers who participate in the VFC program. Regardless, parents should always call ahead to know if their children can be served and what the cost will be.

Second, like many of you, the Health District has historically seen a surge of demand for vaccinations in the fall, when families seek to meet the requirement that their children be vaccinated in order to enroll in school. Providers should consider offering immunization-only appointments during August-October.

Third, refugees and adults with certain medical conditions will need specific vaccinations. The Health District sees most refugees who settle in Snohomish County and will give them specific recommendations to take to their primary care providers. The vaccinations are required to enable refugees to legally change their immigration status. Providers also need to be aware of specific vaccination recommendations for adults with conditions such as HIV infection and asplenia, and should be prepared to offer these vaccinations or refer to other providers or pharmacies that offer these vaccinations. For guidance about specific conditions, see http://www.cdc.gov/vaccines/schedules/hcp/imz/adult-conditions.html.

Fourth, many pharmacies and some urgent care sites offer travel services for adults, but none serve children younger than 5 years old. The Health District will continue to serve families with young children through June. We are working with several providers in Snohomish County to assure travel services for children after June. We will update the provider community over the next three months.

As noted in the March 13 alert, the number of confirmed pertussis cases reported has increased dramatically. In Snohomish County, 30 cases have been reported this year to date, compared to 23 for all of 2014 and 57 in all of 2013. In March alone, the Health District has sent notices to families of students in six schools. Of concern, many cases were missed when first seen by providers, resulting in transmission to family members and others.

Pertussis typically presents with an intermittent, non-productive cough that increases in severity over a period of a few weeks becoming paroxysmal in nature and often associated with whooping and/or vomiting. In infants, apnea (rather than cough) may be the presenting symptom. Testing is appropriate when symptoms are present (but not for asymptomatic contacts) even if the ill person is up to date with pertussis vaccinations.

Recommendations:

Test symptomatic patients (nasopharyngeal swab for PCR) and treat with appropriate antibiotics at time of initial visit.

Exclude ill persons from school, work, or child care until they have completed 5 days of antibiotics.

DO NOT test or exclude asymptomatic (non-infectious) contacts who are being seen for prophylaxis.

Call Communicable Disease Response at 425-339-5278 if you have questions about pertussis management.

Educational Opportunity

Sanofi Pasteur is sponsoring an educational program entitled “A Timely Combination Vaccine for Infants and Toddlers and Understanding and Reducing the Risk of Meningococcal Disease”. The program will be 6:30-8:30 PM on April 9 at the Tulalip Resort. The presenter is Warren Bundle, MD, MS, who is an associate clinical professor with the Department of Family and Community Medicine at the UC Davis School of Medicine. If interested, contact Nick Fisher at nick.fisher@sanofipasteur.com.